Provider Demographics
NPI:1982831814
Name:CHHEDA, SAMIR VISANJI (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:VISANJI
Last Name:CHHEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 ROUTE 38 WEST
Mailing Address - Street 2:PO BOX 479
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-0479
Mailing Address - Country:US
Mailing Address - Phone:609-914-7017
Mailing Address - Fax:
Practice Address - Street 1:210 ARK ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:609-914-7017
Practice Address - Fax:609-261-4180
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA096796002085R0202X
PAMT195569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology